Anxiety, Panic, and Loss of Control in COPD

Anxiety and Chronic Obstructive Pulmonary Disease

Anxiety is common in patients with chronic obstructive pulmonary disease (COPD). As many as half of all patients with COPD have a clinical anxiety disorder. Anxiety is particularly severe during acute exacerbations and breathlessness. However, patients with COPD are known to experience anxiety at other times, and little is known about the emotions, triggers, impact, or management of anxiety in patients with stable COPD living in the community. The purpose of this study was to explore and describe these experiences.

Study Summary

This small qualitative study interviewed 14 patients (9 women and 5 men) recruited from pulmonary rehabilitation and community supports groups in England. Patients completed an anxiety and depression scale to determine the severity of their symptoms.
On the basis of anxiety and depression scale scores, 5 patients had clinically significant symptoms of depression, 6 had clinically significant anxiety symptoms, and 4 had both. Five of the patients with anxiety had a past clinical diagnosis of generalized anxiety disorder, for which 4 had been treated, although all had discontinued their treatment. The analysis found 3 global themes:

• Relationships with breathing -- anxiety was described as both a symptom and a cause of breathlessness. Although breathlessness was a trigger for both anxiety and panic for some patients, for others, episodes were idiopathic and could be trigged by many situations, such as social discomfort and misplacing medications. The relationship between anxiety and breathing was experienced as a vicious cycle by some patients. Living with anxiety was challenging, and patients voiced a fear of breathlessness that could be disabling.
• Fighting for control -- anxiety was a fight for control and associated with panic and helplessness at times. The process of taking control was described as logical and systematic, with self-talk an important and critical strategy. The battle for control was vital in preventing panic episodes. Medication was seen as an important component of controlling COPD, so having medication available was seen as controllable and integral.
• Panic attacks as life changing -- panic attacks were described as traumatic and isolating. Patients felt trapped or smothered, with some describing panic as "near-death experiences." These episodes had a lasting effect and resulted in a persistent fear of recurrence with some describing "meta-worry" (worry about worry) that sometimes led to future attacks. Fear of anxiety caused some patients to become housebound.

Viewpoint

This study, like many studies in the nursing literature, is limited by its very small and nonrandom sample. It is impossible to extrapolate the experiences of these patients to the larger population of all COPD patients. However, these researchers describe an important methodology for exploring a critical component of a very common chronic disease. Clearly more research is needed, particularly in defining the self-management skills described by some patients as important in controlling anxiety and preventing panic attacks. This information could lead to patient education strategies that will assist clinicians in teaching patients these important skills and improving the quality of life for a large segment of this population.

Tips on how to control anxiety attacks step-by-step

To the sufferer an anxiety attack can really be something that is extremely crippling and will undoubtedly have a major impact on the quality of life that they lead. It does, therefore, make sense to understand the steps that can be taken in order to control an anxiety attack before it happens in order to lessen the impact it has so that being said the following are eight tips that you should know about.

How to control Anxiety Attacks

Think about why you are having one
This may sound a very basic tip; however, by trying to understand what has triggered the attack you can actually start to control it. There will always be some reason behind it no matter if it is worrying about going somewhere, money problems, or relationship issues so being able to put your finger on the reason why will then allow you to start to work to overcome it.

Always remember that you are actually in control

It has to be said that for some people this will be extremely difficult to do during an attack as the body and mind appears to be racing and there is a feeling that everything is spiralling out of control. However, it does actually make a difference if you are able to repeat to yourself that you are actually in control and by doing this the feelings that you have inside will start to subside.

Drink some water

Drinking some water is widely accepted as being a fantastic way to control an anxiety attack and you should look at drinking some whilst telling yourself you are in control. A number of attacks are due to the body being dehydrated, which then leads to more stress so the water will help you in a number of ways as it also takes your mind off what is happening.

Get some fresh air into your lungs

If you are indoors when you have one, then you are advised to get some fresh air even if this is just standing next to an open window. One common feeling amongst people is that the world is closing in and there is a certain stuffy feeling, but by breathing in some nice clean air it does start to help calm the body down. This then takes away the idea that you cannot breathe, which is often one of the main problems people have during an attack.

Focus on your breathing

At some point depending upon your personal preference you should look at trying to focus on your breathing and work at taking long and steady breaths. Look at breathing in through your nose and out through your mouth and do try to hold it in for around four seconds in between. This will help to calm you down and it does also allow you to take your mind off other things by making you focus on one of the most basic things we do in our lives.

Visualize yourself in a better situation

By playing this form of a mind trick on yourself it will help to slow down the body as you start to visualize a situation that is a lot calmer and more peaceful for you. Look at trying to build up this image with it gradually getting nicer rather than suddenly transporting your mind to the end result as you will then benefit from it over a longer period of time.

Move

At some point you are going to need to move, but doing so in a controlled manner. This sometimes leads to people trying to dance or do some kind of exercise as it will also burn off some of the excess energy that you now have coursing through your veins and if you allow that to continually build, then the anxiety attack can often last a lot longer.

Have something that you know relaxes you

The final tip is to have an activity or some interest that you know relaxes you no matter if it is listening to a certain group of songs or reading a book. The idea behind this is that it will help you to remain calm in the aftermath of an attack and make it less likely that it will then come back straight away. Look at setting aside even just thirty minutes once you feel calm to do this before resuming whatever you were doing before. Those are eight tips on what to do when faced with having an anxiety attack and they do follow certain steps; however, people often have their own individual ways of dealing with an anxiety attack depending upon which order works best for them. The key is to know about them in advance and plan what you will do so when the next attack hits you instantly know how to deal with it and prevent it from being too bad.

The 10 best ever anxiety management techniques

These techniques fall into three typical clusters:

• the physical arousal that constitutes the terror of panic
• the ‘wired’ feelings of tension that correlated with being ‘stressed out’
• the mental anguish of rumination – a brain that wont stop thinking distressing thoughts

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Cluster One: Physical Arousal

Distressing Physical Arousal – sympathetic arousal causes the heart thumping, pulse-racing, dizzy, tingly, shortness of breath physical symptoms, that can come out of the blue and are intolerable when not understood. Even high levels of anxiety can cause physical tension in the jaw, neck and back as well as an emotional somatic feeling of doom or dread in the pit of the stomach, which will set off a mental search for what might be causing it.

Method 1: Manage the body.

• Eat right
• Avoid alcohol, nicotine, sugar and caffeine
• Exercise
• On going self care
• Sleep
• Consider hormonal changes

Method 2: Breathe

Breathing will slow down or stop the stress response
Do the conscious, deep breathing for about 1 minute at a time, 10-15 times per day every time you are waiting for something eg., the phone to ring, an appointment, the kettle to boil, waiting in a line etc.

Method 3: Mindful Awareness

Close your eyes and breathe; noticing the body, how the intake of air feels, how the heart beats, what sensations you can feel in the gut etc

• With eyes still closed, purposefully shift your awareness away from your body to everything you can hear or smell or feel through your skin
• Shift awareness back and forth from your body to what’s going on around you

You will learn in a physical way that you can control what aspects of the world – internal or external –you’ll notice, giving you an internal locus of control and learning that when you can ignore physical sensations, you can
stop making the catastrophic interpretations that bring on panic or worry. It allows you to feel more in control and mindful of the present.

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Cluster Two: Tension, Stress and Dread

Many people with anxiety search frantically for the reasons behind their symptoms in the hope that they can ‘solve’ whatever problem it is, But since much of their heightened tension isn’t about a real problem, they are wasting their time running around an inner maze of perpetual worry.  Even if the tension stems from psychological or other causes, there are ways to eliminate the symptoms of worry.
These methods are most helpful for diminishing chronic tension.

Method 4: Don’t listen when worry calls your name

This feeling of dread and tension comprises a state of low grade fear, which can also cause other physical symptoms, like headache, temporomandibular joint pain and ulcers. The feeling of dread is just the emotional manifestation of physical tension.
You must first learn that worry is a habit with a neurobiological underpinning. Then apply relaxation to counteract the tension that is building up.
This ‘Don’t Listen’ method decreases the tension by combining a decision to ignore the voice of worry with a cue for the relaxation state.
To stop listening to the command to worry, you can say to yourself: “Its just my anxious brain firing wrong”. This is the cue to begin relaxation breathing which will stop the physical sensations of dread that trigger the radar.

Method 5: Knowing, Not Showing, Anger

When you fear anger because of past experience, the very feeling of anger, even though it remains unconscious, can produce anxiety To know you’re angry doesn’t require you to show you’re angry.
A simple technique: Next time you feel stricken with anxiety, you should sit down and write as many answers as possible to this question, “If I were angry, what might I be angry about?” Restrict answers to single words or brief phrases.
This may open the door to get some insight into the connection between your anger and your anxiety.

Method 6: Have a Little Fun

Laughing is a great way to increase good feelings and discharge tension. Getting in touch with fun and play isn’t easy for the serious, tense worrier.
A therapy goal could be simply to relearn what you had fun doing in the past and prescribe yourself some fun.

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Cluster Three: The Mental Anguish of Rumination

These methods deal with the difficult problem of a brain that won’t stop thinking about distressing thoughts or where worry suffocates your mental and emotional life. These worries hum along in the background, generating tension or sick feelings, destroying concentration and diminishing the capacity to pay attention to the good things in life.
Therapy does not need to focus on any specific worry, but rather on the act of worrying itself – the following methods are the most effective in eliminating rumination.

Method 7: Turning it Off

If a ruminating brain is like an engine stuck in gear and overheating, then slowing or stopping it gives it a chance to cool off. The goal of ‘turning it off’ is to give the ruminative mind a chance to rest and calm down.
Sit quietly with eyes closed and focus on an image of an open container ready to receive every issue on your mind. See and name each issue or worry and imagine putting it into the container.  When no more issues come to mind, ‘put a lid’ on the container and place it on a shelf or in some other out of the way place until you need to go back to get something from it.  Once you have the container on the shelf, you invite into the space that is left in your mind whatever is the most important current thought or feeling.
At night, right before sleep, invite a peaceful thought to focus on while drifting off.

Method 8: Persistent Interruption of Rumination

Ruminative worry has a life of its own, consistently interfering with every other thought in your mind. The key to changing this pattern is to be persistent with your attempts to use thought stopping and thought replacement.  Its important to attempt to interrupt the pattern every time you catch yourself ruminating – you’ve spent a long time establishing this pattern and it will take persistence to wear it down.
Thought stopping – use the command “Stop” and/or a visual image to remind yourself that you are going into an old habit. The command serves as a punishment and a distractor.
Thought replacement – substitute a reassuring, assertive or self-accepting statement after you have managed to stop the thought. You may need to develop a set of these statements that you can look at or recall from memory.

Method 9: Worry Well, but Only Once

Some worries just have to be faced head-on, and worrying about them the right way can help eliminate secondary, unnecessary worrying. When you feel that your worries are out of control try this next method:

1. Worry through all the issues within a time limit of 10-20 mins and cover all the bases
2. Do anything that must be done at the present timeSet a time when it’ll be necessary to think about the worry again
3. Write that time on a calendar
4. Whenever the thought pops up again say, “Stop! I already worried” and divert your thoughts as quickly as possible to another activity – you may need to make a list of these possible diversions beforehand.

Method 10: Learn to Plan Instead of Worry

A big difference between planning and worrying is that a good plan doesn’t need constant review. An anxious brain, however, will reconsider a plan over and over to be sure it’s the right plan.  This is all just ruminating worry disguising itself as making a plan and then seeking constant reassurance.
It is important to learn the fundamentals of planning as it can make a big difference in calming a ruminative mind. These include:

1. Concretely identifying the problem
2. Listing the problem solving options
3. Picking one of the options
4. Writing out a plan of action

To be successful in this approach, you must also have learned to apply the thought-stopping/thought-replacing tools or you can turn planning into endless cycles of replanning.
Once a plan has been made you can use the fact that you have the plan as a concrete reassurance to prevent the round-robin of ruminative replanning. The plan becomes part of the thought-stopping statement, “Stop! I have a plan!”  It also helps the endless reassurance-seeking, because it provides written solutions even to problems the ruminator considers hopelessly complex.

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Conclusion

These skills do require patience and determination. However, once learnt, people gain a lasting sense of their own power and competence in working actively with their own symptoms to conquer anxiety through their own efforts.

Social Anxiety Disorder & Social Phobia : Symptoms, Self-Help, and Treatment

Many people get nervous or self-conscious on occasion, like when giving a speech or interviewing for a new job. But social anxiety, or social phobia, is more than just shyness or occasional nerves. With social anxiety disorder, your fear of embarrassing yourself is so intense that you avoid situations that can trigger it. But no matter how painfully shy you may be and no matter how bad the butterflies, you can learn to be comfortable in social situations and reclaim your life.

What is social anxiety disorder / social phobia?

Matthew’s story

Matthew skipped class today. It’s the first day of the new semester, and he’s afraid that the professor will go around the class and have the students introduce themselves. He knows it shouldn’t be a big deal, but it really stresses him out. Whenever he has to speak in front of more than just a few people, his voice starts shaking and his face gets red. He always feels so humiliated afterwards.
Since public speaking is Matthew’s worst nightmare, he’s been avoiding a speech class he has to take in order to graduate. He’s also dreading his brother’s wedding, even though it’s over six months away. As the best man, he’ll have to give a toast at the reception and he’s already nervous about it.

Social anxiety disorder, also known as social phobia, involves intense fear of certain social situations—especially situations that are unfamiliar or in which you feel you’ll be watched or evaluated by others.
These social situations may be so frightening that you get anxious just thinking about them or go to great lengths to avoid them.
Underlying social anxiety disorder or social phobia is the fear of being scrutinized, judged, or embarrassed in public. You may be afraid that people will think badly of you or that you won’t measure up in comparison to others. And even though you probably realize that your fears of being judged are at least somewhat irrational and overblown, you still can’t help feeling anxious.
While it may seem like there’s nothing you can do about the symptoms of social anxiety disorder or social phobia, in reality, there are many things that can help. It starts with understanding the problem.

Common social phobia / social anxiety disorder triggers

Although it may feel like you’re the only one with this problem, social anxiety or social phobia is actually quite common. Many people struggle with these fears. But the situations that trigger the symptoms of social anxiety disorder can be different.
Some people experience anxiety in most social and performance situations, a condition known as generalized social anxiety disorder. For other people with social phobia, anxiety is connected with specific social situations, such as speaking to strangers, eating at restaurants, or going to parties.
The most common specific social phobia is fear of public speaking or performing in front of an audience.

Triggers for social anxiety disorder (social phobia)

The following situations are often stressful for people with social anxiety disorder:

Meeting new people Being the center of attention Being watched while doing something Making small talk Public speaking Performing on stage Being teased or criticized Talking with “important” people or authority figures

Being called on in class Going on a date Making phone calls Using public bathrooms Taking exams Eating or drinking in public Speaking up in a meeting Attending parties or other social gatherings

Signs and symptoms of social anxiety disorder / social phobia

Just because you occasionally get nervous in social situations doesn’t mean you have social anxiety disorder or social phobia. Many people are shy or self-conscious — at least from time to time — yet it doesn’t get in the way of their everyday functioning. Social anxiety disorder, on the other hand, does interfere with your normal routine and causes tremendous distress.
For example, it’s perfectly normal to get the jitters before giving a speech. But if you have social anxiety disorder or social phobia, you might worry for weeks ahead of time, call in sick to get out of it, or start shaking so bad during the speech that you can hardly speak.

Emotional symptoms of social anxiety disorder / social phobia

• Excessive self-consciousness and anxiety in everyday social situations
• Intense worry for days, weeks, or even months before an upcoming social situation
• Extreme fear of being watched or judged by others, especially people you don’t know
• Fear that you’ll act in ways that that will embarrass or humiliate yourself
• Fear that others will notice that you’re nervous

Physical symptoms of social anxiety disorder / social phobia

• Red face, or blushing
• Shortness of breath
• Upset stomach, nausea (i.e. butterflies)
• Trembling or shaking (including shaky voice)
• Racing heart or tightness in chest
• Sweating or hot flashes
• Feeling dizzy or faint

Behavioral symptoms of social anxiety disorder / social phobia

• Avoiding social situations to a degree that limits your activities or disrupts your life
• Staying quiet or hiding in the background in order to escape notice and embarrassment
• A need to always bring a buddy along with you wherever you go
• Drinking before social situations in order to soothe your nerves

Social anxiety disorder / social phobia in children

There’s nothing abnormal about a child being shy, but children with social anxiety disorder or social phobia experience extreme distress over everyday activities and situations such as playing with other kids, reading in class, speaking to adults, taking tests, or performing in front of others. Often, children with social phobia don’t want to go to school.

Social anxiety disorder treatment #1: Challenge negative thoughts

Social anxiety sufferers have negative thoughts and beliefs that contribute to their anxiety. If you have social anxiety disorder, or social phobia, you may find yourself overwhelmed by thoughts like:

“I know I’ll end up looking like a fool.” “My voice will start shaking and I’ll humiliate myself.”

“People will think I’m stupid.” “I won’t have anything to say. I'll seem boring.”

Challenging these negative thoughts, either through therapy or on your own, is one effective way to reduce the symptoms of social anxiety disorder.
The first step is to identify the automatic negative thoughts that underlie your fear of social situations. For example, if you‘re worried about an upcoming work presentation, the underlying negative thought might be: “I’m going to blow it. Everyone will think I’m completely incompetent.”
The next step is to analyze and challenge them. It helps to ask yourself questions about the negative thoughts: “Do I know for sure that I’m going to blow the presentation?” or “Even if I’m nervous, will people necessarily think I’m incompetent?” Through this logical evaluation of your negative thoughts, you can gradually replace them with more realistic and positive ways of looking at social situations that trigger your anxiety.

Unhelpful thinking styles involved in social phobia

In particular, ask yourself if you’re engaging in any of the following unhelpful thinking styles:

• Mind reading – Assuming you know what other people are thinking, and that they see you in the same negative way that you see yourself.
• Fortune telling – Predicting the future, usually while assuming the worst will happen. You just “know” that things will go horribly, so you’re already anxious before you’re even in the situation.
• Catastrophizing – Blowing things out of proportion. If people notice that you’re nervous, it will be “awful,” “terrible,” or “disastrous.”
• Personalizing – Assuming that people are focusing on you in a negative way or that what’s going on with other people has to do with you.

How can I stop thinking that everyone is looking at me?

In order to reduce self-focus, pay attention to what is happening around you, rather than monitoring yourself or focusing on symptoms of anxiety in your body:

• Look at other people and the surroundings.
• Really listen to what is being said (not to your own negative thoughts).
• Don't take all the responsibility for keeping conversations going—silence is okay, other people will contribute.

Adapted from: Moodjuice

Social anxiety disorder treatment #2: Learn to control your breath

Many changes happen in your body when you become anxious. One of the first changes is that you begin to breathe quickly. Overbreathing throws off the balance of oxygen and carbon dioxide in your body—leading to more physical symptoms of anxiety, such as dizziness, a feeling of suffocation, increased heart rate, and muscle tension.
Learning to slow your breathing down can help you bring your physical symptoms of anxiety back under control. Practicing the following breathing exercise will help you stay calm when you’re the center of attention.

A breathing exercise to help you keep your calm in social situations

• Sit comfortably with your back straight and your shoulders relaxed. Put one hand on your chest and the other on your stomach.
• Inhale slowly and deeply through your nose for 4 seconds. The hand on your stomach should rise, while the hand on your chest should move very little.
• Hold the breath for 2 seconds.
• Exhale slowly through your mouth for 6 seconds, pushing out as much air as you can. The hand on your stomach should move in as you exhale, but your other hand should move very little.
• Continue to breathe in through your nose and out through your mouth. Focus on keeping a slow and steady breathing pattern of 4-in, 2-hold, and 6-out.

Relaxation techniques for anxiety relief

In addition to deep breathing exercises, regular practice of relaxation techniques such as meditation, yoga, and progressive muscle relaxation will also help you get control over the physical symptoms of anxiety.
For step-by-step advice on getting started, see Relaxation Techniques for Stress Relief: Finding the Relaxation Exercises that Work for You.

Social anxiety disorder treatment #3: Face your fears

One of the most helpful things you can do to overcome social anxiety disorder, or social phobia, is to face the social situations you fear rather than avoid them. Avoidance keeps social anxiety disorder going.

Avoidance leads to more problems

While avoiding nerve-wracking situations may help you feel better in the short term, it prevents you from becoming more comfortable in social situations and learning how to cope. In fact, the more you avoid a feared social situation, the more frightening it becomes.
Avoidance may also prevent you from doing things you’d like to do or reaching certain goals. For example, a fear of speaking up may prevent you from sharing your ideas at work, standing out in the classroom, or making new friends.

Challenging social anxiety one step at a time

While it may seem impossible to overcome a feared social situation, you can do it by taking it one small step at a time. The key is to start with a situation that you can handle and gradually work your way up to more challenging situations, building your confidence and coping skills as you move up the “anxiety ladder.”
For example, if socializing with strangers makes you anxious, you might start by accompanying an outgoing friend to a party. Once you’re comfortable with that step, you might try introducing yourself to one new person, and so on.

Working your way up the social phobia “anxiety ladder”

• Don’t try to face your biggest fear right away. It’s never a good idea to move too fast, take on too much, or force things. This will backfire and reinforce your anxiety.
• Be patient. Overcoming social anxiety takes time and practice. It’s a gradual step-by-step progress.
• Use the skills you’ve learned to stay calm, such as focusing on your breathing and challenging negative assumptions.

Social anxiety disorder treatment #4: Build better relationships

Actively seeking out and joining supportive social environments is another effective way of tackling and overcoming social anxiety disorder or social phobia. The following suggestions are good ways to start interacting with others in positive ways:

• Take a social skills class or an assertiveness training class. These classes are often offered at local adult education centers or community colleges.
• Volunteer doing something you enjoy, such as walking dogs in a shelter, or stuffing envelopes for a campaign — anything that will give you an activity to focus on while you are also engaging with a small number of like-minded people.
• Work on your communication skills. Good relationships depend on clear, emotionally-intelligent communication. If you find that you have trouble connecting to others, learning the basic skills of emotional intelligence can help.

Social anxiety disorder treatment #5: Change your lifestyle

While lifestyle changes alone aren’t enough to overcome social phobia or social anxiety disorder, they can support your overall treatment progress. The following lifestyle tips will help you reduce your overall anxiety levels and set the stage for successful treatment:

• Avoid or limit caffeine. Coffee, tea, caffeinated soda, energy drinks, and chocolate act as stimulants that increase anxiety symptoms.
• Drink only in moderation. You may be tempted to drink before a party or other social situation in order to calm your nerves, but alcohol increases your risk of having an anxiety attack.
• Quit smoking. Nicotine is a powerful stimulant. Smoking leads to higher, not lower, levels of anxiety.
• Get adequate sleep. When you’re sleep deprived, you’re more vulnerable to anxiety. Being well rested will help you stay calm in social situations.

When self-help for social anxiety / social phobia isn’t enough

The best treatment approach for social anxiety disorder varies from person to person. You may find that self-help strategies are enough to ease your social anxiety symptoms. But if you’ve tried the techniques above and you’re still struggling with disabling anxiety, you may need professional help as well.

Therapy for social anxiety disorder / social phobia

Of all the professional treatments available, cognitive-behavioral therapy (CBT) has been shown to work the best for treating social anxiety disorder, or social phobia. Cognitive-behavioral therapy is based on the premise that what you think affects how you feel, and your feelings affect your behavior. So if you change the way you think about social situations that give you anxiety, you’ll feel and function better.
Cognitive-behavioral therapy for social phobia typically involves:

• Learning how to control the physical symptoms of anxiety through relaxation techniques and breathing exercises.
• Challenging negative, unhelpful thoughts that trigger and fuel social anxiety, replacing them with more balanced views.
• Facing the social situations you fear in a gradual, systematic way, rather than avoiding them.

While you can learn and practice these exercises on your own, if you’ve had trouble with self-help, you may benefit from the extra support and guidance a therapist brings.

Group therapy for social anxiety disorder / social phobia

Other cognitive-behavioral techniques for social anxiety disorder include role-playing and social skills training, often as part of a therapy group.
Group therapy for social anxiety disorder uses acting, videotaping and observing, mock interviews, and other exercises to work on situations that make you anxious in the real world. As you practice and prepare for situations you’re afraid of, you will become more and more comfortable and confident in your social abilities, and your anxiety will lessen.

Medication for social anxiety disorder / social phobia

Medication is sometimes used to relieve the symptoms of social anxiety, but it’s not a cure for social anxiety disorder or social phobia. If you stop taking medication, your symptoms will probably return full force. Medication is considered most helpful when used in addition to therapy and other self-help techniques that address the root cause of social anxiety disorder.
Three types of medication are used in the treatment of social anxiety disorder / social phobia:

• Beta blockers – Beta blockers are used for relieving performance anxiety. They work by blocking the flow of adrenaline that occurs when you’re anxious. While beta blockers don’t affect the emotional symptoms of anxiety, they can control physical symptoms such as shaking hands or voice, sweating, and rapid heartbeat.
• Antidepressants – Antidepressants can be helpful when social anxiety disorder is severe and debilitating. Three specific antidepressants—Paxil, Effexor, and Zoloft—have been approved by the U.S. Food and Drug Administration for the treatment of social phobia.
• Benzodiazepines – Benzodiazepines are fast-acting anti-anxiety medications. However, they are sedating and addictive, so they are typically prescribed only when other medications for social phobia have not worked.

Social Anxiety

My own story

The symptoms of social anxiety are covered on the ‘Anxiety Explained’ page. Here I want to share my own story of how I managed to come through it, as so many people can become socially crippled when meeting and talking with others.
Before I suffered with anxiety I was a very happy and confident person; social situations never bothered me in the slightest. I would not say I could talk in front of a thousand people, but generally I was pretty confident and had little trouble with social situations.
When anxiety first hit me, I worried continuously about what was causing the sensations I was feeling. I thought deeply, day in, day out, trying to figure a way out of my own personal hell. With this extra worry and stress on my already tired body, I began to feel more anxious than ever. Not only that, but by being so concerned about myself daily, I was beginning to feel detached from my surroundings and my anxiety consumed me. This feeling of detachment made it very hard for me to hold a conversation and I became very self-aware, distant and odd. I would hardly be listening to or engaging in the conversation and would feel quite detached from it, which led to me either wanting to run away from the situation or babbling as I tried to hide how I felt. All I wanted to do was get it over with and I used to get some very strange looks at times. I would also avoid eye contact and just wanted to escape. Because of this I started avoiding people and I was perceived as ignorant more than once. I don't blame people for this perception of me and as far as I was concerned that was far better than having to go and talk to others. I just found it so difficult to hold a conversation and I never felt part of it. I had basically developed social anxiety.

When things began to improve

When I finally built up my understanding and found the answers to the way I was feeling, a lot of my symptoms began to leave me. One thing that didn’t change and I just took for granted, was that conversations continued to be hard work. I still felt odd and not part of them, not as much as I once did, but they were still something to be avoided. I just thought it was something I would have to live with and turned down a few offers where I knew I would have to speak with people. I never even considered it was a form of social anxiety at the time as I did not have the sweating and blushing symptoms that I had read so much about. I did not mind people, I just found it so difficult to hold a conversation and make eye contact without the feelings of detachment and being so self-aware.

The realisation

As others who know me will tell you, I never wanted to settle for just getting through with safety behaviours and I had to get to the bottom of why I felt this way. I first realised it was social anxiety by understanding the simple truth that it was social situations I struggled with. This was brought about by me avoiding people because of how I felt - don't speak to people and you won’t feel odd and detached, you won't make a fool of yourself and look stupid; far better to avoid the situation - WRONG!
This went on for years as I had taught my subconscious mind to see people as something to be avoided. As soon as I saw a person I may have to speak with, my reaction was instant: 'Oh no, here we go again, quick get it over with'. It was precisely this attitude that I had to overcome. Nothing would ever change while I was thinking like this, consciously or otherwise. I had to begin to no longer see meeting people socially as a problem and, more than anything, this had to start with no longer caring if I came across as odd and detached, as this really was at the route of my problem. This was not going to be easy as there was so much habit and memory at work, but there had been a time when I was not like this and I just had to reverse the process back to the old me.

What I began to do

I actually remember the first time I decided to stop avoiding and hit the bogeyman head on. It came when I was meeting a friend in a pub who had brought someone with him. After a quick hello my friend went to the toilet and left me with his friend. This was my ultimate nightmare, being left with someone I did not know and no one to help keep the conversation going. I was on my own. So off I went making my usual false excuse to go elsewhere when the light came on; I was doing it again - avoiding! This behaviour would never change if I kept this up. Only one person could reverse this and that was me. So I actually turned around and thought “Sod it, I am doing this? It's a person, not a bleeding lion”. I began to talk with him and it went quite well, far better than I thought. I had for once not run away or made excuses to rush off. I mean, what could be so bad about talking to someone? The answer was ‘nothing’. If I felt odd or distant from now on, then so be it, I would no longer care. I would not run away from a social situation again, however it went. I was going to reverse this process come what may. If avoidance got me in this hole, the opposite would get me out of it. I just had to get used to it again and see it as normal.

My first steps

There were times when I would start a conversation and try to distract myself, sometimes by watching the TV or pretending to text on my phone, just to avoid eye contact, but I had to snap myself out of these habits. This half hearted attempt was no good. Put your phone down and talk to the person. Don't avoid eye contact, go straight into it. The odd feelings may hit at first, that was fine and only natural, they would subside. I was finally beginning to reverse this process. Finally, I was moving forward and teaching my body that this was normal. There was nothing to fear or run away from and it was finally accepting that message. While I ran away or avoided the situation, I was sending the message that there was a problem.
In time I began to feel far less self-conscious and far less self-aware. It was becoming second nature now. I was sending all the right signals to my body - “Look, there is nothing to be afraid of. I no longer need your protection. I’m fine now”.
Things just got so much easier and the old me - the person that could chat away freely - was coming back. I had no urge whatsoever to find a quick exit or avoid eye contact. The new habit had become me and I no longer took notice of my instinct to run away. I was back in charge. This all came through a habit that I had created myself and the only way to reverse it was to just put myself back out there and in future if ever I felt like pulling away, I would actually do the opposite and go towards.
If I had carried on avoiding I would still be in the same hole now. I think I just wanted to wake up one day and find it was not a problem any more. I wanted to just magically wake up and be able to chat freely to people again without any problems. Well I waited too many years for that day. Only one person could help me and that was me. Avoidance had been my jailer for so long until I regained control and became the person I once was.

Anxiety Troubled Friends & Family: 15 Do's & Don'ts

Can you imagine what it would feel like without your anxiety holding you back?
Can you envision how amazing your life would be if your anxiety completely disappeared?
Hold on to those thoughts and don’t lose hope.

• Learn whether your mental and physical symptoms are caused by anxiety.
• See how your problems compare with those of the average anxiety patient.
• Understand which factors may be working together to source your anxiety.

When you succeed overcoming your anxiety, you will feel like you have been reborn as a new, happier person. In a few years you’ll be able to look back and feel proud of yourself for curing your anxiety and becoming a happier you.
Start right now. The test is free, and the results will reveal much about your anxiety.

Often, family and friends really want to know is, "What can I do to help?" Therefore, we recommend the following list of helpful suggestions, as a result of listening and learning from our clients. So, here's a list of do's and don't's for those who are closest to you.
1. DON'T criticize. Sufferers of panic attacks have real physical symptoms. They are probably more critical of themselves than you are. Remember that negative comments can contribute to slowing down their progress by adding stress and making them feel guilty for their feelings!
2. DO encourage rather than shame or embarrass them. They are already tackling a difficult situation, so positive support will pay off for everyone in the end.
3. DON'T induce guilt when the anxious person is unable to do certain things. It is hard for them to deal with their limitations anyway, and adding guilt will only alienate you from the person you most want to help.
4. DON'T express disappointment, anger, or frustration if a setback occurs. When trying to overcome a problem like this, every effort is an accomplishment, with the potential for other, greater accomplishments in the future.
5. DO notice and compliment their efforts to conquer their fear, as well as their actual successes. Your affirmation will help build their confidence.
6. DO be empathic. Try to understand the problem from their point of view. They don't need your pity, but your help, your encouragement, and your support.
7. DO be willing to accompany them on practice ses¬sions if they ask you to. This means going along because you want to help, not because you feel obligated.
How Family and Friends Can Help 61
8. DO be quick to point out their positive qualities. Give them the same consideration you would want for yourself.
9. DO listen when they need to talk. It can be a great relief for them to share their distress. Also, listening becomes an opportunity to gently encourage their attempts to cope.
10. DO allow them to be in charge whenever you can. The ability to make decisions and take action is a real aid to self-confidence and helps them realize that control is possible.
11. DO avoid surprises. Let them know what is going to happen and when, so they can make plans to deal with any panic that may arise.
12. DO help them identify their successes. Change can be so gradual that improvements may go unnoticed and a sense of progress is very important.
13. DO work with them to identify family patterns, situations, or concerns that may contribute to the problem. Try to notice and improve any interactions between you that are detrimental to their growth and independence.
14. DO be consistent. Recognize that there will probably be changes as they are better able to handle anxiety and stress. Try not to be threatened by the prospect of their increased self-confidence or potential changes in your relationship. Seek family therapy or marital counseling if necessary.
15. DO be patient! Maybe more than anything, it will help if your loved ones know that, when they finally overcome these attacks, you will be there for them.
The perfect house cannot be built from the roof down. I’ve helped thousands of people overcome their anxiety and panic attacks, and I always start them off with my anxiety test before discussing treatment options.
Understanding your anxiety and its probable causes is crucial, because it gives you a starting point – a steady ground from which you can build toward your well-being.
As such, I recommend you take the quiz even if you have already been diagnosed with anxiety.
This 7 minute anxiety test will:

• Help you find out if (and which) of your symptoms are indeed anxiety.
• Break your anxiety problems into smaller, understandable pieces.
• Show in graphical form the causes that make up your anxiety.
• Describe the next step to overcoming your anxiety problems.

Food and Anxiety | Anti-Anxiety Diet

Unfortunately, through anxiety we sometimes turn to alcohol and establish a bad diet to try and make us feel better in the short term. Changing your diet and lifestyle can help many forms of anxiety and the symptoms that go with it.
As I was recovering, I decided to eat healthier and found that, through this, I had so much more energy, felt calmer and less depressed. I also understood the importance of burning off all my excess nervous energy and took up a fitness campaign that suited me.
These changes in my life made a lot of difference to how I felt overall. They are not the only answer to anxiety, but they can bring some much needed relief to the way we feel.
Try and eat a healthy, whole foods diet with plenty of fresh vegetables and fruits. Try and include foods that are rich in the B vitamins, such as whole grains, nuts, green vegetables, eggs and fish
To help lift moods and help calm anxiety, keep away from processed foods and eat more natural products. Also what we drink can have an affect on our stress levels. Although drinking alcohol seems to have a calming effect short term, it dehydrates the body, leaving us feeling more anxious than ever. If you feel you can't give up altogether, then just try and moderate it.
Avoid fizzy drinks loaded with sugar, instead drink plenty of water, I am personally not a big fan of water and drink the flavoured variety which is fine also. Avoid caffeine too much caffine, again there is no need to give it up completely, just try and moderate it.
Below is a small list of foods to avoid and which foods to keep on your side when you are feeling anxious or stressed. Again I don't expect you to be perfect as I was not, but a few changes may help you see the benefit.

Foods to eat

Yogurt
Bananas
Vegetables
Wholegrain foods
Brown Rice
Beans
Turkey
Chicken
Cottage Cheese
Fresh Fish
Poached Egg
Tuna
Fruit
Porridge
Baked potato
Peanut butter
Garlic
Spinach

Foods to avoid

Fizzy drinks
Processed food
White bread
Chips
Pastry
Cakes
Caffeine
Sugar
Alcohol
Chocolate
Cheese
Fast Food

If you want more help and advice with anxiety and panic issues then do please take the time to look around my site.